Part I: General Information
A. Introduction
The Northern Indiana Health Care System VA Medical Center (NIHCS) Marion and Fort Wayne campuses anticipates an award of a firm fixed price Indefinite Delivery, Indefinite Quantity contract for Advanced Life Support (ALS) and Basic Life Support (BLS) Ambulance Service and wheelchair van accessible transportation. ALS and BLS services are those life support transportation services which utilize ambulances, paramedics, emergency medical technicians, equipment and facilities subject to the rules of the Indiana Department of Public Health, Health Facilities Services Administration, Emergency Medical Services, Department of Revenue, National Registry Emergency Medical Technician and the Department of Health and Human Services (HHS). All Paramedics, EMTs, ambulance vehicles and companies shall be licensed in the State of Indiana, EMS Rules and Laws http://www.in.gov/dhs/3531.htm.
The requirements for ALS, BLS and Wheelchair Van transportation services shall be issued under one Statement of Work (SOW). There may be multiple awards off one solicitation. One award may be made for ALS and one award may be made for BLS/Wheelchair Van
Transportation. The Government reserves the right to make a single award for ALS and for BLS/Wheelchair Van Transportation or multiple awards.
B. Scope
1. Advanced Life Support (ALS)
The contractor shall provide all vehicles, personnel, management, supplies,
transportation, equipment, materials, and reports necessary to furnish 24 hour a day, 7 day a week ALS ambulance services. All services provided under this contract shall be scheduled in advance, unless circumstances prevent it, with the contractor to include emergency ALS ambulance transportation. ALS services are those life support
transportation services which utilize ambulances, paramedics, EMTs, and equipment. All are subject to the rules of the Indiana Department of Public Health, Health Facilities Services Administration, Emergency Medical Services, National Registry Emergency Medical Technician and HHS. Any waivers or variances granted to the contractor by the State of Indiana or HHS from applicable regulations shall first be approved by the
Contracting Officer (CO). Services shall be furnished only by the contractor. The Contractor may not subcontract any services required under this contract without prior written approval from the CO.
2. Basic Life Support (BLS) and Wheelchair Van Transportation
The contractor shall provide all vehicles, personnel, management, supplies,
transportation, equipment, materials, and reports necessary to furnish 24 hour a day, 7 day a week BLS ambulance services and wheelchair van transportation services for NIHCS. All services provided under this contract shall be scheduled in advance, unless circumstances prevent it, with the contractor to include non-emergency BLS ambulance transportation and wheelchair van services as required. BLS services are those life support transportation services which utilize intermediate emergency medical
technicians, ambulances, and equipment subject to the rules of the Indiana Department of
Public Health, Health Facilities Services Administration, Emergency Medical Services,
National Registry Emergency Medical Technician and HHS and ADA. Any waivers or variances granted to the contractor by the State of Indiana or HHS from applicable regulations shall first be approved by the CO. Services shall be furnished only by the contractor. The Contractor may not subcontract any services required under this contract without prior written approval from the CO.
C. Applicable Documents
Indiana Administrative Code – Title 836 Indiana Emergency Medical Services commission
http://www.nasemso.org/legislation/Indiana/inti836ar1.html
Indiana Department of Homeland Security http://www.in.gov/dhs/3525.htm
All ambulance vehicles used in the performance of this contract shall be licensed and meet the minimum vehicle requirements, as mandated by Federal Specifications KKK-A-1822F, dated July 2015.
(https://www.nasemso.org/Projects/AgencyAndVehicleLicensure/documents/KKK-A-1822F-change-notice8-01July2015-FINAL.pdf)
All VA Medical Center policies and procedures shall be followed by the contractor.
http://www.jointcommission.org/standards_information/standards.aspx
National Registry Emergency Medical Technician – www.nremt.org - 836 IAC 4-4-3 Certification based upon reciprocity – www.nremt.org
Indiana Code TITLE 16 Article 31. EMERGENCY MEDICAL SERVICES IC 16-31-3 Chapter 3. Certification Requirements for the Provision of Emergency Medical Services IC 16-31-3-2 – For Company and Vehicles from out of State http://www.nasemso.org/legislation/Indiana/inti16ar31chap3.html
EMS Rules and Laws http://www.in.gov/dhs/3531.htm
836 IAC 1 basic ambulance service providers.
836 IAC 2 advanced life support providers.
836 IAC 4 training and personnel certifications
Continuing Education and Certification http://www.in.gov/dhs/3530.htm
Department of Revenue - ADA
http://www.in.gov/dor/files/3_1_FMCSA_Resource_Guide_2011.pdf
Part II: Work Requirements
A. Technical Requirements for Advance Life Support
1) Timeliness:
Contractor shall respond within 30 minutes of a request for patient transport for ALS.
2) Number of Patients:
Contractor shall only transport one patient on an ALS ambulance trip unless specifically authorized by NIHCS. When more than one patient is transported on a trip,
reimbursement shall be made at the rate not exceeding the cost of transportation of a
single patient, however, when travel beyond the city limits is involved, the longest
distance over which a patient is transported may be claimed when more than one patient
is transported in a single ambulance concurrently. Contractor shall ensure that the
“pick-ups” and “drop-offs” are scheduled so that the total distance traveled shall result in the most economical charge to the Government.
3) Orders:
Requests for services shall be made by telephone, in writing, or by fax by the transportation coordinator or designee.
If the Contractor fails to furnish services within the required time frame stated above in paragraph 8, VA reserves the right to obtain such services from another source and to charge the Contractor with any excess costs above the contract price associated with obtaining the services from the alternate source. VA retains the sole authority to determine when to order services from another source.
Acceptance of the trip shall obligate the contractor’s ambulance crew to arrive within the required time period and/or to assume payment of the difference in billing rate if they fail to meet this deadline and the VA subsequently goes off contract to secure transport on the open market. Contractor shall be responsible for costs incurred for services obtained from an alternate source for any orders not accepted by the contractor that are within the ordering requirements of FAR 52.216-19.
4) Vehicles:
a) The ambulance(s) under the terms of this contract shall be licensed and meet the minimum vehicle requirements as mandated by the Indiana Department of
Homeland Security http://www.in.gov/dhs/3525.htm . Each vehicle shall include the required equipment in strict compliance with the federal, state and local laws, ordinances, codes, rules or regulations and shall have a minimum not less than the following:
Air conditioning, heating and ventilation for patient comfort.
Form of communications device in case of an emergency, i.e., CB radio, cellular phone
Equipped with an American Red Cross Type 24 Unit first aid kit or equivalent.
All vehicles shall be kept in a sanitary condition both inside and outside.
Vehicles involved in an accident, no matter how insignificant shall be taken out of operation until the contractor has provided written repair documentation to the COR.
Vehicles involved in an accident transporting a NIHCS patient shall contact the VA Medical Center Mobility Manager office within 2 hours following the incident.
b) NIHCS reserves the right to inspect ambulances utilized for the performance of
the contract requirements at any time. Mechanical defects noted at the time of
inspection shall be corrected prior to being placed into service. Maintenance of
vehicles and their equipment shall be on a periodic basis and meet or exceed
manufacturer's recommendations. All vehicles shall be reasonably maintained and
maintenance records must be kept and made available for inspection by the
CO/COR upon request.
5) Ambulance and Medical Equipment: Each emergency medical care vehicle shall have patient compartment facilities, oxygen and suction system equipment, environmental climatic equipment, and additional systems equipment, accessories, and supplies as required by the Indiana Emergency Medical Services Commission, and Federal
Specification KKK-A-1822F, dated July 2015. ALS transport units are required to have portable ventilator equipment.
6) ALS Personnel:
a) Paramedics shall transport any person(s) who are seriously ill with the aim of stabilizing them before they are taken to the hospital for medical treatment in accordance with the Indiana Emergency Medical Services Commission.
b) The Paramedic shall be certified, licensed or otherwise officially recognized by the local, state, or regional government or public entity where the emergency ambulance service is operated or by which it is governed.
http://www.in.gov/dhs/3531.htm - IC 16-31-3-1Certification or license required.
c) The Paramedic shall be enrolled periodically in continuing education, or advanced training programs as required by the local or state government entity in which the service is rendered to Veterans but in no instance shall this be less frequently than every two years. Such continuing education shall be equivalent to that developed by the Department of Transportation, National Highway Safety Administration.
Evidence of successful completion for training shall be submitted to the CO for inspection. http://www.in.gov/dhs/3530.htm
d) Routine duties for ALS include:
Determine blood glucose levels
Oxygen & pulse oximetry
Cardiac Monitoring
Administer standard intravenous (IV) solutions of Normal Saline (NS) &
Lactated Ringers (LR)
Insert nasogastric tubes for administration of Activated Charcoal
Insert Esophageal Tracheal Combi Tube
Perform Needle Cricothyrotomy
Oral Endotracheal intubation
Nasal Endotracheal intubation
Endotracheal suction
Administer drugs through the following routes:
Sublingual
Subcutaneous
Intramuscular
Intravenous
Endotracheal
Perform needle thoracotomy to relieve tension pneumothorax
Application of splints
Order trauma alert (and request aero medical helicopters for serious
trauma patients with significant mechanisms of injury or a grade of less
than 12 on the Glasco Coma scale
Basic Cardiac Life Support (BCLS) in accordance with current Cardio-Pulmonary Resuscitation standards
Advanced Cardiac Life Support (ACLS) in accordance with ACLS protocols, to include defibrillation, cardioversion, and external pacing if the Paramedic has current documentation of successful ACLS course completion
Treatment of acute respiratory failure
Patient Controlled Analgesia (PCA) pump with any medication or fluid infusing through a peripheral IV
Medication infusing through a peripheral IV or continuous subcutaneous catheter via a closed, locked system
A central catheter that is clamped off (subclavian, Hickman, PICC, and Passport)
A patient with a feeding tube that is clamped off
A patient with a Holter monitor
A patient with a peripheral IV infusing vitamins
IV fluids infusing through a peripheral IV via gravity or an infusing system that allows the technician to change the rate of infusion are limited to D5W, Lactated Ringers, Sodium Chloride (0.9% or less), Potassium Chloride (20mEq or less for EMTs, 40mEq or less for Advanced EMTs)
Medication infusing through a peripheral or central IV or fluid infusing through a central IV via gravity or an infusing system that allows the operator or assistant to change the rate of infusion
A patient with a chest tube
A patient with a continuous feeding tube
A vent dependent patient
e) Non-Emergency Attendant/Driver(s):
Technicians and drivers shall be capable of administering oxygen and have successfully completed the Standard and Advanced First Aid Courses of the American Red Cross of U.S. Bureau of Mines, or equivalent. Proof in the form of a current certificate that such first aid training has been successfully completed shall be available upon request.
f) Certified Nursing Assistant:
1) When required and authorized a Certified Nursing Assistant (CNA) shall accompany the patient to the destination and provide necessary assistance. A paramedic or EMT may be substituted for the CNA, but shall be required to perform duties as stated below. The amount of assistance required for these activities ranges from the need for total care (i.e. change urine or colostomy bag or Attends, special diet, oxygen, ) to a requirement for minimal guidance (i.e.
assistance from stretcher to wheelchair, help with food tray, help in finding clinical destination). This assistance may include:
Help in meeting appointment schedules
Assistance for meals, and management of meal tickets
Aid in restroom activities
Help getting to other areas such as x-ray, lab
Constant supervision and care of confused and disabled patients
2) CNA equivalent education and training may be submitted in lieu of state certification. The Manager, Patient Support Services, in collaboration with the Mobility Manager shall approve equivalent education and training, as an acceptable substitute, on a case-by-case basis.
B. Technical Requirements for Basic Life Support and Wheelchair Van Transportation
1) Timeliness:
Contractor shall respond within one (1) hour of a request for BLS patient transport.
Contractor shall respond within 1.5 hours of a request for Wheelchair Van Transport.
2) Number of Patients:
More than one patient may be transported on a BLS run or wheelchair van transport when authorized. When more than one patient is transported on a trip, reimbursement shall be made at the rate not exceeding the cost of transportation of a single patient, however, when travel beyond the city limits is involved, the longest distance over which a patient is transported may be claimed when more than one patient is transported in a single
ambulance concurrently. Contractor shall ensure that the “pick-ups” and “drop-offs” are scheduled so that the total distance traveled shall result in the most economical charge to the Government.
3) Orders:
Requests for services shall be made by telephone, in writing, or by fax.
If the Contractor fails to furnish services within the required time frames stated above, VA reserves the right to obtain such services from another source and to charge the Contractor with any excess costs above the contract price associated with obtaining the services from the alternate source. VA retains the sole authority to determine when to order services from another source.
Acceptance of the trip shall obligate the contractor’s ambulance crew to arrive within the required time period and/or to assume payment of the difference in billing rate if they fail to meet this deadline and the VA subsequently goes off contract to secure transport on the open market. Contractor shall be responsible for costs incurred for services obtained from an alternate source for any orders not accepted by the contractor that are within the ordering requirements of FAR 52.216-19.
Wheelchair van runs shall be scheduled 24 hours in advance of the trip when possible.
4) Vehicles:
The ambulance and wheelchair vans under the terms of this contract shall be licensed and meet the minimum vehicle requirements as mandated by the Indiana Department of Homeland Security http://www.in.gov/dhs/3525.htm and Department of Revenue – ADA.
http://www.in.gov/dor/files/3_1_FMCSA_Resource_Guide_2011.pdf . Each vehicle
shall include the required equipment in strict compliance with the federal, state and local
laws, ordinances, codes, rules or regulations and shall have a minimum not less than the
following:
Air conditioning, heating and ventilation for patient comfort.
Form of communications device in case of an emergency, i.e., CB radio, cellular phone
Equipped with an American Red Cross Type 24 Unit first aid kit or equivalent.
All vehicles shall be kept in a sanitary condition both inside and outside.
Vehicles involved in an accident, no matter how insignificant shall be taken out of operation until the contractor has provided written repair documentation to the COR.
Vehicles involved in an accident transporting a NIHCS patient shall contact the VA Medical Center Mobility Manager office within 2 hours following the incident.
5) NIHCS reserves the right to inspect ambulances and Wheelchair Vans utilized for the performance of the contract requirements at any time. Mechanical defects noted at the time of inspection shall be corrected prior to being placed into service. Maintenance of vehicles and their equipment shall be on a periodic basis and meet or exceed
manufacturer's recommendations. All vehicles shall be reasonably maintained and maintenance records must be kept and made available for inspection by the CO/COR upon request.
6) Ambulance and Medical Equipment:
Each emergency medical care vehicle shall have patient compartment facilities, oxygen and suction system equipment, environmental climatic equipment, and additional systems equipment, accessories, and supplies as required by the Indiana Emergency Medical Services Commission, and Federal Specification KKK-A-1822F, dated July 2015. ALS transport units are required to have portable ventilator equipment.
7) Personnel:
Emergency Medical Technician (EMT):
8) Routine duties include:
In accordance with the Indiana Emergency Medical Services Commission, EMTs and Advanced EMTs may transport any of the following under control of the provider organization’s medical director:
PCA pump with any medication or fluid infusing through a peripheral IV
Medication infusing through a peripheral IV or continuous subcutaneous catheter via a closed, locked system
A central catheter that is clamped off (subclavian, Hickman, PICC, and Passport)
A patient with a feeding tube that is clamped off
A patient with a Holter monitor
A patient with a peripheral IV infusing vitamins
IV fluids infusing through a peripheral IV via gravity or an infusing system that allows the technician to change the rate of infusion are limited to D5W, Lactated Ringers, Sodium Chloride (0.9% or less), Potassium Chloride (20mEq or less for EMTs, 40mEq or less for Advanced EMTs)
9) Non-Emergency Attendant/Driver(s):
Technicians and drivers shall be capable of administering oxygen and have successfully completed the Standard and Advanced First Aid Courses of the American Red Cross of U.S. Bureau of Mines, or equivalent. Proof in the form of a current certificate that such first aid training has been successfully completed shall be available upon request.
10) Certified Nursing Assistant:
a) When required and authorized a Certified Nursing Assistant (CNA) shall accompany the patient to the destination and provide necessary assistance. A paramedic or EMT may be substituted for the CNA, but shall be required to perform duties as stated below. The amount of assistance required for these activities ranges from the need for total care (i.e. change urine or colostomy bag or Attends, special diet, oxygen) to a requirement for minimal guidance (i.e.
assistance from stretcher to wheelchair, help with food tray, help in finding clinical destination) This assistance may include:
Help in meeting appointment schedules
Assistance for meals, and management of meal tickets
Aid in restroom activities
Help getting to other areas such as x-ray, lab
Constant supervision and care of confused and disabled patients
b) Training:
CNA equivalent education and training may be submitted in lieu of state certification. The Manager, Patient Support Services, in collaboration with the Mobility Manager shall approve equivalent education and training, as an acceptable substitute, on a case-by-case basis.
C. Requirements for Advance Life Support & Basic Life Support License/Certifications:
1) Any lapse in any overall contractor (the Company, ambulances, and employees) licensure that is not corrected within 12 hours shall result in the contractor being Terminated for Cause.
2) All Paramedic and intermediate EMT’s, and Registered Nurses and LPN’s shall be registered in the National Registry EMT and licensed in the State of Indiana, http://www.in.gov/dhs/files/20110420-IR-836100361FRA.pdf
3) 836 IAC 4 training and personnel certifications http://www.in.gov/dhs/3530.htm 4) Continuing Education and Certification http://www.in.gov/dhs/3530.htm
D. Safety Requirements:
In performance of this contract the contractor shall take such safety precautions as the CO or the
COR may determine to be reasonably necessary to protect the lives and health of patients, and
occupancy of the vehicle. The CO or COR shall notify the contractor of any noncompliance
In performance of this contract the contractor shall take such safety precautions as the CO or the
COR may determine to be reasonably necessary to protect the lives and health of patients, and
occupancy of the vehicle. The CO or COR shall notify the contractor of any noncompliance
